RFP Self Insured HMO Final Draft .docx

Central Management Services Self-Insured HMO

26-416CMS-BENF4-B-51689

Attachment IV Section A. SCOPE OF WORK

A.1. OVERVIEW AND PURPOSE

The Illinois Department of Central Management Services (“CMS” or “Agency”) requests proposals from responsible Offerors to meet its needs. A brief description is set forth below for the Offeror’s convenience, with detailed requirements in subsequent sections of this solicitation. If interested and able to meet these requirements, the State appreciates and welcomes an Offer.

Brief Description:

CMS is requesting proposals for organizations to administer a self- insured HMO Plan for enrollees in the State Employees Group Insurance Program (SEGIP), Local Government Health Plan (LGHP), Teachers’ Retirement Insurance Program (TRIP), and College Insurance Program (CIP). The combined, current HMO plan enrollment in these four Programs is approximately 62,200 lives. Appendix 1 Census Data Self Insured HMO RFP.xlsx contains current enrollment data by county and carrier. The State may award to the most responsive and responsible offeror(s) whose offer best meets the specified criteria. The State reserves the right to make multiple awards, within specific service areas, to meet its managed care coverage needs and to comply with the collective bargaining agreement with AFSCME.

A.2. DESIRED OUTCOMES OF THIS PROJECT/ENGAGEMENT

The selected vendor(s) will administer self-insured HMO plan(s) including medical, facility/professional, behavioral health services, excluding pharmacy, for enrollees in the State Employees Group Insurance Program (SEGIP), Local Government Health Plan (LGHP), Teachers’ Retirement Insurance Program (TRIP), and College Insurance Program (CIP) as outlined in the Statement of Work below.

A.3. SCHEDULE & BUDGET

Solicitation Posting – April 2026 Bid Opening – May 2026 Technical Evaluation – June 2026 Anticipated Award – July 2026 Contract Execution – December 2026

A.4. TERM

A.4.1. TERM OF THIS CONTRACT: The contract resulting from this procurement will have an initial term commencing July 1, 2027, through June 30, 2030. In no event will the total term of the contract, including the initial term, any renewal terms, and any extensions, exceed ten (10) years. Vendor shall not commence billable work in furtherance of the contract prior to final execution of the contract except when permitted pursuant to 30 ILCS 500/20-80.

A.4.2. RENEWAL: Subject to the maximum total term identified above, the State has the option to renew for seven (7) years in one of the following manner(s):

· One renewal covering the entire renewal allowance;

· Individual one-year renewals up to and including the entire renewal allowance;

· Or any combination of full or partial-year renewals up to and including the entire renewal allowance.

A.4.2.1. Pricing for the renewal term(s), or the formula for determining price, is in the Pricing section of this solicitation.

A.4.2.2. Any renewal of the resulting contract is subject to the same terms and conditions that apply to the initial term of the contract unless otherwise provided. The State may renew the contract for any or all of the option periods specified, may exercise any of the renewal options early, and may exercise more than one option at a time based on continuing need and favorable market conditions, when in the best interest of the State. The contract may neither renew automatically nor renew solely at the Vendor’s option.

Section B. CURRENT CONDITIONS

B.1. OVERVIEW & BACKGROUND

CMS oversees the administration of group health benefits for four separate and distinct Programs (SEGIP, TRIP, CIP, and LGHP), which collectively cover approximately 450,000 lives. The statutory authority for the Programs is the State Employees Group Insurance Act of 1971, as amended, 5 ILCS 375/1 et seq. (available at https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=120&ChapterID=2 ), hereinafter referred to as the "Act".

There are approximately 278,138 in SEGIP, 3,735 in LGHP, 18,005 in TRIP, and 1,795 in CIP eligible for coverage. Approximately 62,200 currently have HMO coverage (total for all four plans combined). The statutory authority for the program is the State Employees Group Insurance Act of 1971, as amended, 5 ILCS 375/1 et seq. (Act). Generally, the annual Benefit Choice Period for each Program is May 1 through May 31. Enrollees will enroll for an effective date of coverage to begin on July 1 for each year. The Agency has entered into a contract with a Benefit Administration Solution (BAS) vendor, Telus Health, to include: electronic enrollment, premium and payroll deduction calculation, communication, education and other administrative services. The BAS vendor’s system is the file of record for enrollment and eligibility. The BAS vendor transmits Member election data and Member and dependent eligibility data on a weekly basis to requisite plan administrators. Program information including employee handbooks can be found for each group at the following links.

1. State Employee Group Insurance Program State Employee Benefits

2. Teachers Retirement Insurance Program Teachers’ Retirement Insurance Program

3. Local Government Health Insurance Program Local Government Health Plan (LGHP) Benefit Plans

4. College Insurance Program College Insurance Program (CIP) Benefit Plans

Section 3 of the Act defines and establishes base criteria for those eligible to participate. The current statutory definition, or as amended in the future, will prevail on all questions of eligibility to participate. CMS determines eligibility and the on-line enrollment vendor, currently Telus Health, furnishes original enrollment information and weekly updates of changes to the Vendor. Vendor must accept all determinations of eligibility for enrollees as transmitted to them by the on-line enrollment vendor (Telus Health). Enrollment with Vendor is only valid if the enrollment has been entered into Telus Healths’ electronic membership file. Effective January 1, 2021, the Agency implemented a rolling MAPD enrollment transitions retirees, members and their covered dependents that are Medicare eligible to one of the Medicare Advantage Prescription Drug plans. CMS anticipates that this will impact approximately 8,000 lives annually.

Special enrollments outside of the Benefit Choice period may be allowed at the discretion of the Director of CMS. The Director of CMS shall declare a Benefit Choice period(s) to allow Enrollees to change from one offered health plan to another. Such period shall be announced at least once per year, usually May 1 – May 31, or more often, as the Director of CMS deems appropriate. With the exception of those families where a member is covered under the MAPD plan - the remaining family members who are not Medicare eligible would remain in the plan chosen prior to the employee moving to the MAPD. Dependent then becomes the member.

Medicare-eligible persons are in a separate Medicare Advantage program and are not included in this procurement.

Changes in elections and resulting premium adjustments may be effective retroactively for up to six months from the month in which the change is reported to the enrollee's Insurance Representative. At the discretion of CMS, exceptions to this retroactive adjustment policy may be made in order to comply with the Act. Vendor shall provide for a continuation and conversion privilege for enrollees in accordance with Section 6.2 of the Act (5 ILCS 375/6.2) and Sections 367.2 and 367e of the Illinois Insurance Code (215 ILCS 5/367.2 and 5/367.e). The Agency reserves the right to make program and plan benefit design changes during the term of any resulting contract.

The Agency introduced Medicare Advantage Prescription Drug Plans (MAPD) effective February 1, 2014. Accordingly, some Enrollees will migrate out of QCHP, TCHP, and CCHP to the MA-PD plans on or before January 1 each year due to the Agency implementing a rolling MAPD enrollment policy.

Currently, covered Dependents must be enrolled in the same plan as the Member. Effective July 1, 2025, the State implemented a split household initiative allowing member and dependent(s) to be enrolled in two different plans based on Medicare eligibility. Accordingly, if a Medicare-eligible Member has a Dependent who is NOT Medicare-eligible, this Member will move to a MAPD plan, and the dependent will remain an enrollee in their current health insurance plan. The current method for Coordination of Benefits (COB) is a Standard COB. The Agency bases COB off of the National Association of Insurance Commissioners and Medicare Secondary Payer Guidelines.

Prescription benefits will be carved-out and are not included in this procurement. However, the medical plan and prescription benefit all coordinate to a single out of pocket maximum.

Accordingly, the selected Vendor must have the capability to pass deductible and claims information to the Prescription Benefit Manager (CVS Health) for purposes of tracking plan year maximums, out of pocket maximums, deductibles, and other related medical information.

The vision (EyeMed) and dental benefits (Delta Dental) are carved out and are not included in this procurement. However, the selected Vendor(s) may be requested to interface with the plan administrator for either or both benefits.

The Agency has contracted for post payment claim review services with SmartLight Analytics. The selected vendor must have the capability to pass claims information to SmartLight Analytics for review and analysis.

The Agency has established a wellness program for employees referred to as Be Well Illinois and partners with contracted vendors to deliver wellness initiatives, including an incentive program. The selected Vendor must have the capability to pass specified preventative care claims information to the contracted vendor on a monthly basis. For more information about Be Well Illinois, go to https://cms.illinois.gov/benefits/stateemployee/bewell.html

B.2. VOLUMES & QUANTITIES

Any figures or utilization numbers provided by the Agency do not guarantee future utilization or needs. The selected Vendor(s) must render the necessary services throughout the Contract period, regardless of whether the utilization is more or less than the estimate initially provided by the Agency. Offerors shall use the data provided to respond to both the Responsiveness Elements and Price components of the RFP. These sections detail the specific requirements and needs determined by the Agency as well as any other specifications. This information should be used by the Offeror to prepare its Offer and will be incorporated as terms in the resulting Contract. Information contained in the proposal submitted by the selected Vendor(s) is subject to acceptance by Agency or negotiation with Agency.

B.2.1. Please refer to Appendix 1 Census Data Self Insured HMO RFP

B.3. AREAS OF CONCERN/CHALLENGES

B.3.1. Current or future budget constraints may result in a delay in payments. At this time, it is not known if or when a delay may be implemented. Interested offerors need to be able to handle this payment delay while providing all contractual services.

Section C. PROPOSAL REQUIREMENTS Deloitte assisted in preparing this RFP and will participate in the evaluation of the Offers received. Individuals from Deloitte involved in preparing and evaluating Offers are required to sign confidentiality statements in compliance with Illinois procurement law. In their Offers, Offerors must disclose and identify the nature of any affiliation or relationships, including but not limited to business relationships, with Deloitte. Certain affiliations (e.g. parent/subsidiary, family member, etc.) may prevent the Agency from accepting an Offer if the Offeror is determined by the Chief Procurement Officer to be a prohibited Offeror. Offerors are to complete Section Attachment I., “Disclosure of Affiliation or Relationship with Deloitte.” If a relationship is not disclosed, an Offer may be rejected.

Only Electronic Submissions through BidBuy of Offers will be Accepted

C.1. REQUIRED DOCUMENTS TO COMPLETE AND SUBMIT

The Offeror shall submit the listed documents in BidBuy under the Attachments tab in the appropriate “Required Attachments” spaces.

· Vendor Disclosure or IPG Active Registered Vendor Disclosure

· Technical response including Appendix 2 Provider Disruption

· Offer to the State of Illinois

· Commitment to Diversity

· G.2. General and Clinical Performance Guarantees

· Pricing Appendix 3 Detailed Network Discount and Appendix 4 Self Insured HMO Pricing Worksheet.xlsx

· BEP Utilization Plan Blank documents may be found on the Chief Procurement Officer for General Service’s website at https://cpo-general.illinois.gov/solicitation-and-contract-templates.html and on the BidBuy posting under “File Attachments:”. Business Enterprise Program/Veterans Small Business Program Utilization Plan may be downloaded from the Commission on Equity and Inclusion’s website at https://cei.illinois.gov/purchasing-entity-resources/compliance.html.

Failure to submit Vendor Disclosure or IPG Active Registered Vendor Disclosure, as applicable, and the Utilization Plan(s), as applicable, with the Offer submitted in BidBuy shall render the Offer non-responsive.

Offerors are required to submit their response to the State’s solicitation through BidBuy. Any information sent to the State outside of BidBuy, for example by US Mail, FedEx, UPS, e-mail, or hand delivery, will neither be accepted nor considered. Offeror submissions will only be considered if they are received through BidBuy and on or before the time and date indicated as the “Bid Opening Date” on the BidBuy posting. Any required attachments must be submitted via BidBuy.

Price entries on the Items tab will be locked automatically upon submission of the quote. Entering cost, pricing or discount information in the Alternate Description may result in disqualification. If the agency requires pricing to be submitted in an attachment, Offeror shall upload pricing under the “Required Documents” section on the Attachments tab and check the box “Does the attachment contain any pricing, cost or discount information?”. Failure to check this box allows your pricing to be viewed when bids are opened and will result in disqualification of your offer. NOTE: Do not check “Does the attachment contain any pricing, cost or discount information” if the attachment does NOT include pricing, cost, or discount information.

Documents shall be submitted in an electronic format that is accessible and readable using Microsoft Office suite software or Adobe Reader. Corrupted files shall not be considered. It is the Offeror’s responsibility to check that files are accessible and legible after uploading.

The Offeror is solely responsible for ensuring timely submission of their electronic solicitation response. Failure to allow adequate time prior to the Bid Opening Date to complete and submit a response to a solicitation, particularly in the event technical support assistance from the State is required, places the Offeror and their offer or response at risk of not being accepted.

The State encourages the Offeror to ensure that their BidBuy account is up-to-date. It is recommended that you access your BidBuy account prior to the solicitation due date and time to make sure that your company’s information is up-to-date and your password is current. Files may be uploaded at any time prior to submission.

File size may impact the uploading and downloading speed and may lead to browser time-outs, resulting in failed upload/download attempts. Please consider this dependency when attaching very large documents.

OFFEROR INSTRUCTIONS TO SUBMIT IN BIDBUY

Create Quote:

Note: any pricing entered in the Unit Cost of the Items Tab will be locked until after Technical Evaluations take place. Do not enter cost, pricing, or any discount information in the Alternate Description field. Entering cost, pricing or discount information in the Alternate Description may result in disqualification.

Note: If taking any exceptions to Standard Terms and Conditions an offeror must submit a redline version of the Standard Terms and Conditions with their proposal.

: “Upload” (next to each required attachment) : “Choose File” Note: If a pricing document is required, mark the box next to the question, “Does this attachment contain any pricing, cost, or discount information?”

Failure to mark this box when attaching a pricing document will result in disqualification.

Check this box ONLY if a separate pricing document is required.

Do NOT check this box for any other required quote attachment such as the Technical Proposal, Vendor Disclosure / IPG Active Registered Vendor Disclosure, or Utilization Plan(s), or Offer.

Offerors may also view the “Request for Proposal (RFP) Vendor Submission Instructions Video found at https://cpo-general.illinois.gov/vendor-resources.html

C.2. DUE DATE AND TIME FOR SUBMISSION OF OFFERS

Each solicitation contains the Offer due date and time, appearing as the “Bid Opening Date:” on the BidBuy posting. Offeror shall submit Offers in BidBuy, and the State shall open Offers electronically in BidBuy on the “Bid Opening Date”. The Offer must remain firm for 180 days from opening.

C.3. CONFLICT BETWEEN INFORMATION IN ELECTRONIC DOCUMENTS AND ON BIDBUY

If the State provides information in electronic documents (i.e., the RFP and other attachments) that is different or in conflict with the information the State provides on BidBuy, then the information in electronic documents is presumed to represent the State’s intent. If the Offeror provides information in electronic documents that is different or in conflict with the information the Offeror provides in BidBuy through their Seller Account, then the information in electronic documents shall represent the Offeror’s intended submission.

C.4. PUBLISHED PROCUREMENT INFORMATION

The State publishes procurement information, including solicitations, awards, and amendments, on the Chief Procurement Officer for General Services’ Illinois Procurement Bulletin, known as the Bulletin or BidBuy (https://www.bidbuy.illinois.gov/bso/). Procurement information may not be available in any other form or location. Offeror is responsible for monitoring BidBuy. The State will not be held responsible if Offeror fails to receive the optional e-mail notice of future amendments to the solicitation.

C.5. INFORMATION CONTACT

The individual listed in the “Info Contact:” field on the BidBuy posting shall be the single point of contact for this solicitation. Unless otherwise directed, Offeror should only communicate with the Information Contact. The State/Agency shall not be held responsible for information provided by or to any other person.

Suspected errors should be immediately reported to the Information Contact. Do not discuss, directly or indirectly, the solicitation or any Offer with any State officer or employee other than the Information Contact.

C.6. OFFEROR QUESTIONS AND AGENCY RESPONSE

All questions, other than questions raised at the Pre-Submission Conference, pertaining to this solicitation must be submitted in writing to the Information Contact no later than 14 days before bid opening. Questions received and Agency responses may be posted as a Bid Amendment to the original solicitation on BidBuy; only these posted answers to questions shall be binding on the State. Offeror is responsible for monitoring BidBuy and BidBuy email notifications.

C.7. SMALL BUSINESS SET-ASIDE

In the Bulletin posting, if “Yes” is shown to the question “Is this a Small Business Set-Aside Procurement?”, then Offeror must be registered by the Illinois Small Business Set-Aside Program at the time Offers are due for the Offer to be evaluated. For requirements on qualifying Offeror’s business in the Small Business Set-Aside Program, please go to the Chief Procurement Office for General Service’s website at https://cpo-general.illinois.gov/sell-2-illinois.html .

C.8. BUSINESS ENTERPRISE FOR MINORITIES, WOMEN, AND PERSONS WITH DISABILITIES ACT PARTICIPATION AND UTILIZATION PLAN

The BidBuy posting indicates whether this solicitation contains a goal to include businesses owned and controlled by minorities, women, and persons with disabilities. If this solicitation contains a goal, then failure to complete and submit a Utilization Plan, including documentation demonstrating good faith efforts when requesting a waiver, shall render the Offer non-responsive. 30 ILCS 575/4(e). All questions regarding the subcontracting goal must be directed to the Information Contact indicated in BidBuy no later than 14 days before bid opening.

The NIGP code used to establish this goal is 953-48.

BEP Goal: 5% Go to https://cei.illinois.gov/vendor-resources/get-bep-certified.html for complete requirements for BEP certification. Go to State of Illinois Commission on Equity and Inclusion at https://supplierdiversitymanagementportal.illinois.gov/home.aspx to search for certified BEP vendors.

Go to https://cei.illinois.gov/programs0/veterans-business-program.html for complete requirements for Veteran Owned Small Business (VOSB) or Service-Disabled Veteran Owned Small Business (SDVOSB) certification. Go to State of Illinois Commission on Equity and Inclusion at https://supplierdiversitymanagementportal.illinois.gov/home.aspx to search for certified VOSB and SDVOSB vendors.

C.9. SECURITY

Bid/Performance Bond: $N/A. If a bond is required, Offeror must submit the Bid Bond with your offer or Performance Bond to the Information Contact within ten (10) days after contract execution. The bond must be from a surety licensed to do business in Illinois. An irrevocable letter of credit is an acceptable substitute. The form of security must be acceptable to the State.

C.10. TERMS AND CONDITIONS

Standard Terms and Conditions will become a part of any resulting contract. To view the Standard Terms and Conditions, please go to https://cpo-general.illinois.gov/solicitation-and-contract-templates.html.

Section D. EVALUATION PROCEDURES

D.1. EVALUATION PROCESS

The State assesses each Offer for Responsibility (E.10) and Responsiveness. The State considers the information provided and the quality of that information when assessing Offers. If the State finds a failure or deficiency, the State may reject the Offer or reflect the failure or deficiency in the assessment.

There are three scored parts to each proposal – technical, commitment to diversity, and pricing. Each part of the proposal is evaluated and ranked independently of the other parts of the proposal. The results of the evaluation of all three parts shall be used in ranking the proposals.

The State may award to the most responsive and responsible offeror(s) whose offer best meets the specified criteria. The State reserves the right to make multiple awards, within specific service areas, to meet its managed care coverage needs and to comply with the collective bargaining agreement with AFSCME.

D.2. RESPONSIVENESS

A responsive offeror is one who submits an offer that conforms in all material respects to the Request for Proposal and includes all required forms.

D.2.1. The State will determine whether the Offeror complied with the instructions for submitting offers. Except for late submissions, and other requirements that by law must be part of the submission, the State may require that an Offeror correct deficiencies as a condition of further evaluation.

D.2.2. Subcontractor Disclosure: If the Offer includes any subcontractors, then Offeror shall complete the Subcontractor Disclosure section of the Offer to the State of Illinois.

D.2.3. If completing IPG Active Registered Vendor Disclosure, then responsiveness may include and may not be limited to:

· Active Illinois Procurement Gateway registration # with expiration date

· Certifications timely to this solicitation

· Disclosure of lobbyists for Offeror and parent entity(ies)

· Disclosure of pending and current contracts

D.2.4. If completing Vendor Disclosure, required parts may include and may not be limited to:

D.2.5. The State will determine whether the Offer meets the stated Technical requirements. Minor differences or deviations that have negligible impact on the price or suitability of the supply or service to meet the State’s needs may be accepted or corrections allowed. If no offeror meets a particular Technical requirement, the State may waive that requirement.

D.2.6. When the specification calls for “Brand Name or Equal,” the brand name product is acceptable. Other products will be considered with proof that the other product meets stated specifications and is equivalent to the brand product in terms of quality, performance, and desired characteristics.

D.3. EVALUATION METHODOLOGY

The Technical Requirements are described in Sections F.2. and F.3. The State evaluates the Technical Requirements without consideration of price.

D.3.1. Total Number of Points Available for Technical Requirements is: 1,475.

D.3.2. Offeror shall complete and return Sections F.1, F.2., F.3.

D.3.3. Relative Weight in Point Format

* Deloitte Consulting will evaluate these Technical Elements

D.4. COMMITMENT TO DIVERSITY ELEMENTS

Sections 20-15 and 35-30 of the Illinois Procurement Code (30 ILCS 500/) require offerors to be evaluated on their commitment to diversity. The points available for Commitment to Diversity are described in Section F.4. and are equivalent to 20% of the Technical Requirements points. The State evaluates Commitment to Diversity without consideration of price.

D.4.1. The total number of points for Commitment to Diversity is 295.

D.4.2. Offeror shall complete and return Section F.4 Commitment to Diversity

D.4.3. Commitment to Diversity Categories: The percentages at the end of each section reflect the weighted distribution of points available identified in D.4.1.

Commitment to Diversity Categories

Category 1 – BEP Compliance - Whether the Offeror meets the set goal for contracting or subcontracting with businesses owned by women, minorities, or persons with disabilities or completed a Good Faith Effort Waiver for this procurement. 5%

Category 2 – Subcontracting/Contracting with any WMD businesses (not limited to BEP vendors) - Whether the Offeror has contracted/subcontracted within the prior calendar year with businesses owned by women, minorities, or persons with disabilities. 10%

Category 3 – Diversity, Equity and Inclusion (DEI) Spend – Offeror’s percentage of business, education and/or community spend from prior calendar year gross revenue that involves businesses owned by women, minorities and/or persons with disabilities. The assisted businesses are not required to be certified in the Illinois Business Enterprise Program. 20%

Category 4 – DEI Time - Offeror’s hours spent in the prior calendar year on promoting DEI in the workplace, the community, education institutes, or supporting businesses owned by women, minorities, or persons with disabilities. The assisted business is not required to be certified in the Illinois Business Enterprise Program. The success or failure of each event does not impact the points achieved. The event may be voluntary or paid time. 20%

Category 5 – DEI Policies - Entity has provided a written copy of, or link to, their current written workforce diversity, equity, and inclusion policy. Policies must be actionable plans, not overarching concepts around DEI. 10%

Category 6 – Diversity in Staffing - % of individuals on governing board and/ or Senior executives who identify as women, minorities or person with disabilities. 10% % of individuals in management /supervisor positions who identify as women, minorities or person with disabilities. 13% % of total staff who identify as women, minorities or person with disabilities. 12%

D.5. PRICE

The State opens Price proposals after evaluating all Technical and Commitment to Diversity proposals.

If the State does not consider the price to be fair and reasonable and negotiations fail to meet an acceptable price, the State reserves the right to cancel the award and take appropriate action to meet the needs of the State. The State determines whether the price is fair and reasonable by considering the offer, including the offeror's qualifications, the offeror's reputation, all price proposals submitted, other known prices, the project budget, and other relevant factors.

D.5.1. The total number of points for Price is 1,000. Deloitte Consulting will evaluate Price.

D.5.1.1. Administrative Service Fees 150 points D.5.1.1.1. The State will determine Price points for this price element using the following formula: Maximum of 150 points for the lowest fees. All other vendors will get points reduced by the percentage difference from the lowest fees to their fees multiplied by the maximum number of points.

D.5.1.2. Network Discount by County 400 points D.5.1.2.1. The State will determine Price points for this price element using the following formula: Maximum of 400 points for the highest weighted average discount to their weighted discount multiplied by the maximum number of points. All other vendors will get points reduced by twice the percentage difference from the highest weighted average discounts to their weighted average discounts multiplied by the maximum number of points. If percentage difference is greater than 50%, Offeror will receive 0 points To create the final weighted average discount Agency will use actual State of IL claims utilization by county and claims by service category. Vendors are only evaluated based on Counties for which they are proposing to provide services for.

D.5.1.3. Detailed Network Discount Analysis 250 points D.5.1.3.1. The State will determine Price points for this price element using the following formula:

Maximum of 250 points for the highest weighted average discounts. All other vendors will get points reduced by twice the percentage difference from the highest weighted average discounts to their weighted average discounts multiplied by the maximum number of points. Weighted discounts factor in service categories (IP/OP/prof) as well as claims volume by entity (SEGIP, CIP, LGHP, TRIP). If the difference is greater than 50%, Offeror will receive 0 points.

D.5.1.4. Medical Discount Guarantee 200 points (Split into four elements, with 50% going to the discount, 25% amount at risk, and 12.5% each for corridor and increments.)

D.5.1.4.1. The State will determine Price points for this price element using the following formula:

· Discount Guarantee: Maximum of 100 points for the highest discounts. All other vendors will get points reduced by twice the percentage difference from the highest discounts to their discounts multiplied by the maximum number of points. If percentage difference is greater than 50%, Offeror will receive 0 points.

· Amounts at Risk: Maximum of 50 points for the vendor that provides the highest percentage of its fees at risk. 90% of the maximum points for vendors within 5 percentage points of the highest; 80% for between 6 and 10 percentage points; 70% for between 11 and 15 percentage points. 50% if above 15 percentage points. Zero points if no offer.

· Corridor: 25 points for those that provide 2% corridor or less. 0 points if greater than 2% corridor.

· Increments:25 points for those that provide 1% increments. 0 points if greater than 1% increments.

D.6. MAXIMUM AVAILABLE POINTS

The maximum number of points is 1,475 (Technical) + 295 (Commitment to Diversity) + 1,000 (Price) = 2,770 maximum available points.

Section E. ADMINISTRATIVE REQUIREMENTS

E.1. GOVERNING LAW AND FORUM

Illinois law and rules govern this solicitation and any resulting contract. Offeror must bring any action relating to this solicitation or any resulting contract in the appropriate court in Illinois. This document contains statutory references designated with “ILCS”. To view the full text, go to https://ilga.gov/Legislation/ILCS/Chapters . The Illinois Procurement Code (30 ILCS 500) and the Standard Procurement Rules (44 ILL. ADM. CODE PART 1) are applicable to this solicitation. To view them respectively, go to and Illinois General Assembly - ADMINISTRATIVE CODE.

E.2. PUBLIC RECORDS AND REQUESTS FOR CONFIDENTIAL TREATMENT

Offers become the property of the State. All offers will be open to the public under the Illinois Freedom of Information Act (FOIA) (5 ILCS 140) and other applicable laws and rules, unless Offeror requests in its Offer that the State treat certain information as confidential. A request for confidential treatment will not supersede the State’s legal obligations under FOIA. The State will not honor requests to keep entire Offers confidential. Offerors must show the specific grounds in FOIA or other law or rule that support confidential treatment. Regardless, the State will disclose the successful Offeror’s name, the substance of the Offer, and the price.

If Offeror requests confidential treatment, Offeror must submit additional copy/copies (see Instructions for Submission of Offers in Section C.) of the Offer with proposed confidential information redacted. This redacted copy must tell the general nature of the material removed and shall retain as much of the Offer as possible. In a separate attachment, Offeror shall supply a listing of the provisions identified by section number for which it seeks confidential treatment and identify the statutory basis or bases under Illinois law, including a detailed justification for exempting the information from public disclosure.

Offeror will hold harmless and indemnify the State for all costs or damages associated with the State defending Offeror’s request for confidential treatment. Offeror agrees that the State may copy the Offer to facilitate evaluation, or to respond to requests for public records. Offeror warrants that such copying will not violate the rights of any third party.

E.3. MINORITY CONTRACTOR INITIATIVE

The State requires a fee of $15 to cover expenses related to the administration of the Minority Contractor Opportunity Initiative. Any offeror awarded a contract of $1,000 or more under Section 20-10, 20-15, 20-25 or 20-30 of the Illinois Procurement Code (30 ILCS 500) is required to pay a fee of $15. The Comptroller shall deduct the fee from the first check issued to the Vendor under the contract and deposit the fee in the Comptroller’s Administrative Fund. 15 ILCS 405/23.9.

E.4. FEDERAL FUNDS

The resulting contract may be partially or totally funded with Federal funds. Upon notice of intent to award, the percentage of supplies and/or services involved that are Federally funded and the dollar amount of such Federal funds will be disclosed.

E.5. EMPLOYMENT TAX CREDIT

Offerors who hire qualified veterans and certain ex-offenders may be eligible for tax credits. 30 ILCS 500/45-67 and 45-70. Please contact the Illinois Department of Revenue (217-524-4772) for information about tax credits [35 ILCS 5/216, 5/217].

E.6. RESERVATIONS

Offeror must read and understand the solicitation and tailor the Offer and all activities to ensure compliance. The State reserves the right to amend the solicitation, reject any or all offers, award by item/services, group of items/services, or grand total, and waive minor defects. The State may request a clarification, inspect Offeror’s premises, interview staff, request a presentation, or otherwise verify the contents of the Offer, including information about subcontractors and suppliers. The State may request Best & Final Offers when appropriate. The State will make all decisions on compliance, evaluation, and terms and conditions, and shall make decisions in the best interests of the State and in accordance with the Illinois Procurement Code, rules and other applicable State and Federal statutes and regulations. This competitive process may require that Offeror provide additional information and otherwise cooperate with the State. If an offeror does not comply with requests for information and cooperate, the State may reject the offer as non-responsive to the solicitation. Submitting an offer does not entitle Offeror to an award or a contract. Posting a vendor’s name in a Bulletin notice does not entitle the vendor to a contract. The State is not responsible for and will not pay any costs associated with the preparation and submission of any offer.

Awarded Offeror(s) shall not commence and will not be paid for any billable work undertaken prior to the date all parties execute the contract, unless approved in writing in advance by the State Purchasing Officer or the Chief Procurement Officer (or designee).

E.7. AWARD

The State is not obligated to award a contract pursuant to this solicitation. If the State issues an award, the award will be made to the responsive and responsible offeror(s) whose offer best meets the specified criteria unless otherwise permitted by the Illinois Procurement Code and Illinois Administrative Code. However, if the State does not consider the price to be fair and reasonable and negotiations fail to meet an acceptable price, then the State reserves the right to cancel the award and take appropriate action to meet the needs of the State. The State will determine whether the price is fair and reasonable by considering the offer, including the offeror's qualifications, the offeror's reputation, all prices submitted, other known prices, the project budget and other relevant factors. The State will post a notice to the Bulletin identifying the apparent most responsive and responsible offeror.

E.8. INVOICING ADDRESS

The awarded Vendor shall invoice at the completion of the contract unless invoicing is tied in the contract to milestones, deliverables, or other invoicing requirements agreed to in the contract. The Bulletin posting contains the “Bill-to Address:” where invoices should be sent.

Agency shall self-bill for the Base Administrative Fee. Invoices for any applicable mutually agreed administrative charges, along with supporting documentation, will be provided monthly, as applicable, and are in addition to the self-billed monthly administrative service charge. Supporting documentation of all claims and any mutually agreed administrative charges to be paid shall be submitted concurrently with each request. Invoicing, payment, and any mutually agreed administrative charges shall be detailed separately by each plan under State (SEGIP), TRIP, CIP, and LGHP.

Vendor shall not bill for any taxes unless accompanied by proof that the State is subject to the tax. If necessary, Vendor may request the applicable Agency’s Illinois tax exemption number and Federal tax exemption information.

E.9. PROTEST REVIEW OFFICE

Offeror may submit a written protest to the Protest Review Office following the requirements of the Standard Procurement Rules. 44 ILL. ADM. CODE 1.5550. For protests related to specifications, the Protest Review Office must physically receive the protest no later than fourteen (14) days after the solicitation or related addendum was posted to the Bulletin. For protests related to rejection of individual proposals or awards, the protest must be received by close of business no later than fourteen (14) days after the protesting party knows or should have known of the facts giving rise to the protest. The Protest Review Office’s information is as follows:

Chief Procurement Office Attn: Protest Review Office Email: cpogs.pro@illinois.gov

E.10. RESPONSIBILITY

A responsible Offeror is one who has the capability in all respects to perform fully the contract requirements and who has the integrity and reliability that will assure good faith performance. The State determines whether the Offeror is a “responsible” offeror; an offeror with whom the State can or should do business. For example, the State may consider the following:

E.10.1. A “prohibited bidder” includes any person assisting an employee of the State of Illinois by reviewing, drafting, directing, or preparing any invitation for bids, a request for proposal, or request of information, or providing similar assistance unless such assistance was part of a publicly issued opportunity to review drafts of all or part of these documents. For purposes of this section, an employee of the State of Illinois means one who, by the nature of his or her duties, has the authority to participate personally and substantially in the decision to award a State contract. No person or business shall submit specifications to a State agency unless requested to do so by an employee of the State. No person or business that contracts with a State agency to write specifications for a particular procurement need shall submit a bid or proposal or receive a contract for that procurement need.

Nothing herein is intended to prohibit a vendor from bidding or offering to supply developing technology, supplies or services after providing the State with a demonstration of the developing technology, supplies, or services; provided the subject of the demonstration to the State represents industry trends and innovation and is not specifically designed to meet the State's needs. Nothing herein is intended to prohibit a person or business from submitting a bid or offer or entering into a contract if the person or business: (i) initiates a communication with an employee to provide general information about products, services, or industry best practices and, if applicable, that communication is documented in accordance with Section 50-39 of the Illinois Procurement Code or (ii) responds to a communication initiated by an employee of the State for the purposes of providing information to evaluate new products, trends, services, or technologies.

E.10.2. Other factors that the State may use to evaluate to determine responsibility include, but are not limited to: political contributions, certifications, conflict of interest, financial disclosures, taxpayer identification number, past performance in business or industry, references (including those found outside the Offer), compliance with applicable laws, financial responsibility, insurability, effective equal opportunity compliance, payment of prevailing wages if required by law, capacity to produce or sources of supply, and the ability to provide required maintenance service or other matters relating to the offeror’s ability to deliver in the quality and quantity within the time and price as specified in this solicitation.

E.10.3. Awarded offerors must always have financial resources sufficient, in the opinion of the State, to ensure performance of the contract and must provide proof upon request. The State may require a performance bond if, in the opinion of the State, it ensures performance of the contract. The State may terminate the contract, consistent with the termination for cause provision of the contract, if the vendor lacks the financial resources to perform under the contract.

E.10.4. The State may require that an offeror correct any deficiencies as a condition of further evaluation.

E.11. BidBuy Terminology and Guidance: BidBuy is an online e-procurement system. There may be some difference between the procurement terminology used in this solicitation and the terms used in BidBuy. Please learn more about BidBuy by accessing the online resources found here:

https://www2.illinois.gov/cpo/PathwayToProcurement/Pages/Guides-and-Manuals.aspx

Section F. PROPOSAL FORMS Offeror must complete and return:

· The following three (3) tables include: Contract Requirements (Section F.1), Technical Requirements: Mandatory Requirements with Evidence (Section F.2), and Proposed Technical Solution (Section F.3 including Appendix 2 Provider Disruption.xlsx)

· Commitment to Diversity (Section F.4)

· Offer to the State of Illinois

· General and Clinical Performance Guarantees (Section G.2.)

Please read and follow each instruction carefully.

F.1. CONTRACT REQUIREMENTS

Please read each item carefully and check “Agree” indicating acceptance for each requirement in F.1. An Offeror that does not check “Agree” will be disqualified and the rest of the proposal may not be scored. These Contract Requirements shall be included in any contract resulting from this solicitation.

F.1.1.2. Vendor must provide toll-free telephone and TDD access for customer service that shall be available to all members during regular business hours (8:30 a.m. to 5:00 p.m. CST/CDT). Vendor resources are to include staff and phone lines to maintain customer service, and backup capability to ensure access in the event of a system shutdown.

|_| Agree

F.1.1.5. Vendor shall maintain a holiday closure schedule that coincides with that of the Agency, holiday schedule can be found by clicking the following link: https://cms.illinois.gov/personnel/employeeresources/stateholidays.html Vendor shall be available on all days that the Agency is open for business.

|_| Agree

F.1.1.6. Vendor shall provide within ten (10) calendar days of Vendor’s receipt of notification of any determinations of non-compliance with State or Federal laws, rules, regulations, or guidelines made by any agency charged with the responsibility to make such a determination, to the Agency a copy of such notification with corrective action it has taken. At least monthly thereafter, or more frequently as required by the Agency and until such time as the appropriate State or Federal authority determines that Vendor is again in compliance, Vendor shall provide a written report detailing the corrective measures taken and the status of its negotiations with the State or Federal authority who has determined Vendor's non-compliance.

|_| Agree